According to my health plan, I would benefit from taking part in their disease management program. They have nurses who serve as personal "health coaches," who could help me to "reach my best health," or "understand treatment plans or medications from my doctor," and "discuss the online resources available for me to live a healthier life."
There's just one problem with their thoughtful offer: I don't have a disease. I didn't even catch a cold this winter.
To be fair, I do take 20 milligrams of an ACE inhibitor every day to keep mildly elevated blood pressure in check – I checked yesterday for the heck of it and it was 124/71, so no problems there – and I have what they call "borderline high" LDL cholesterol (143).
However, I also have high HDL cholesterol (55) because I run 2.2 miles, or ski, or ride a bike, or walk nine holes of golf, just about every day. My diet is hearty but healthy in the main. There is no family history of heart attack or heart disease (stroke, yes, heart attack no). My weight fluctuates 2.5 pounds north or south of 197 and has for the past five years. That's less than 10 pounds more than I weighed when I graduated from high school. I feel great.
So I called the number the letter told me to call to find out how I came to receive a disease management letter. I told the customer service rep on the other end of the line I covered health IT policy and implementation for a living, so I was VERY interested in how I came to be selected. As I suspected, it was through claims data and pharmacy data.
We've only been covered by this plan the past 18 months, so they don't have a heck of a lot on me. Four or five quarterly visits to my family physician, which in reality serve mostly as a chance for me to find out what docs like him think of the way Meaningful Use is rolling out for solo and small-office practices. And quarterly refills on the ACE inhibitor. That's it. No longitudinal data beyond late 2012. No family tendencies. Nothing else.
"Well," I asked the unlucky person who drew the short straw of having to deal with me, "how would I opt out of this? Because I think this is a great example of a bad and shallow use of Big Data."
"Are you saying those words?" she asked, perhaps thinking I was speaking from a script, maybe.
"Yes," I said, "I am speaking those words, not as a healthcare journalist but as a customer whom you sent a letter to, knowing very little about me."
"Well, they're not going to know any- and everything about you," she said. "That's not how we base our program."
"That's exactly the point," I said. "In order for it to be truly effective, they'd have to know a lot more about me than that I take Lisinopril."
And that was that. I was presumably put on whatever list of noncompliant malcontents they keep in the darkest and dampest corner of the basement in Hartford, left to a lifetime of bad habits that will drain the system of precious dollars that could better go elsewhere, like executive salaries.
But that letter and phone call are just part of where the company failed to demonstrate they really understand the whole picture around those they cover.
My wife's employer takes part in the plan's corporate wellness program. Participants are encouraged to "join your colleagues in team challenges, track your progress towards your goals, share tips and encouragement with your supporters, and ask others to join you as you create better habits."
My wife and her departmental colleagues participate. She's the team captain. I even came up with their catchy name. But, at least in the case of my wife's company, spouses are not allowed to become part of the effort, at least not in terms of joining a team, getting credit for pursuing some healthy habits, and contributing to a sense of camaraderie such things usually engender. I don't know if that's an overall rule or if it's a company-by-company thing, but for the life of me, I can't figure out how an insurer that says it's interested in helping me lead a healthier life – going so far as to send me letters about a disease I don't have – isn't pushing every button possible to meet that stated goal. Our whole family is covered under her policy, but somebody isn't connecting those wellness dots very well. The proverbial silo problem is still alive and well.
I remember the hubbub CMS stirred up in the late 1990s when the administrators said they were going to demand more in the way of evaluation and management documentation from doctors in Medicare claims. A lot of docs huffed and puffed and complained about how CMS wanted them to practice "cookbook medicine."
Human beings are complicated creatures. And I fear that, before we get a good handle on how to best use Big Data to put the information on millions to the service of the Cohort of One each of us gloriously is, the "cookbook medicine" those docs worried about 15 years ago will look like world-class care. I think it highly likely more and more of us will be getting letters based on the skimpiest of statistics and no more than lip service and half-baked – maybe even cynical – efforts at recognizing we're more than one gnat-sized field in a honkin' big batch SQL query. And the real payback will be nil to negligible.
Those are the words I am saying.